Steatotic Liver Disease Subtypes and their Association with Colorectal Cancer Risk in Korea: A Nationwide Population-Based Study.

Background: A recent Delphi consensus proposed a new classification system for steatotic liver disease (SLD), replacing the previous terminology, non-alcoholic fatty liver disease (NAFLD). This study aimed to examine the association between SLD subtypes and the risk of developing colorectal cancer (CRC).

Methods: We used the Korean National Health Insurance Service database to identify participants who underwent health screenings in 2009 and 2010 and retrospectively analysed their data through to 2019. The participants were grouped into four categories: no SLD, metabolic dysfunction-associated steatotic liver disease (MASLD), MASLD with increased alcohol intake (MetALD), and alcohol-related liver disease (ALD). Hepatic steatosis was defined as a fatty liver index ≥30. The primary outcome was the occurrence of newly diagnosed CRC according to the SLD classification.

Results: This analysis included 242,275 participants. The adjusted hazard ratios for CRC incidence were 1.17 (95% confidence interval [CI]: 1.10-1.25) for MASLD, 1.45 (95% CI: 1.28-1.65) for MetALD, and 1.78 (95% CI: 1.48-2.14) for ALD, with no SLD as the reference group. All results were statistically significant (p < 0.001).

Conclusions: Individuals in Korea with MASLD, MetALD, or ALD are at an increased risk of developing CRC.